Function and Pain Following Knee Replacement

Comparison of Function and Pain Intensity in the Acute Stage Following Total Knee Replacement, Between Different Methods of Post-surgical Pain Relief

The goal of this interventional study is to compare pain management techniques (femoral nerve block, intra-articular block, none) in TKA patients. The main questions it aims to answer are:

• Are there differences in postoperative outcomes?
• Does preoperative quadriceps muscle strength predict early functional ability? Participants underwent TKA and assessments. Researchers compared pain management techniques to assess effects on postoperative outcomes and identified the importance of preoperative quadriceps muscle strength as a predictor of early functional ability. Further research is required to refine postoperative pain management strategies.

Study Overview

• Status: Completed
• Conditions: Pain, Postoperative; Post Operative Pain; Knee Arthropathy
• Intervention / Treatment: Procedure: Femoral nerve block; Procedure: Intra-articular block

Detailed Description

Total knee arthroplasty (TKA) is a frequently undertaken elective orthopedic intervention for severe knee osteoarthritis, frequently yielding postoperative discomfort and complications. Peripheral nerve blocks, notably femoral nerve blocks, are commonly utilized for analgesia but may transiently impede motor nerve function, weakening the quadriceps muscle. Intra-articular blocks offer a potential alternative to mitigate motor impairment. However, there exists a dearth of information regarding the comparative effectiveness of these methods with respect to short-term functional outcomes in the immediate postoperative phase following TKA.

Objectives: This study assesses functional outcomes, pain, quadriceps strength after TKA with femoral nerve block, intra-articular block, and a control group. It identifies predictors of postoperative functional ability.

Methods: 54 patients undergoing TKA were evaluated, measuring pre-op quadriceps strength, and utilizing the Oxford Knee Score for functionality. Post-op, we evaluated mobility using the Timed Up & Go, Elderly Mobility Scale, and Five Times Sit-to-Stand tests on POD 1 & 3/4. Pain levels, hospitalization, surgical duration, complications, and falls were also recorded.

• Study Type: Interventional
• Enrollment (Actual): 54
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Michal Elboim- Gabyzon, Dr; Phone Number: 972545968943; Email: michal.elboim@gmail.com
• Study Contact Backup: Name: Mor Kliger Tendler; Phone Number: 972503623303; Email: mor.kliger@gmail.com

Study Locations

• Israel
  • Nahariya, Israel
    • Galilee Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Men and women, over the age of 18, electively assigned for primary knee replacement surgery.
• ASA score 1-3

Exclusion Criteria:

• Revision surgery
• Patients suffering from chronic pain syndrome or chronic opioid use.
• Patients with previous neurological deficits in the lower extremities.
• A cognitive state that does not allow signing of consent or understanding simple instructions.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Femoral nerve block; Patients undergoing total knee arthroplasty received a single-shot femoral nerve block during the surgical procedure.	Procedure: Femoral nerve block; Patients who receive a femoral nerve block during surgery, fill out a questionnaire and undergo a muscle strength test before surgery, undergo functional tests, a muscle strength test and are asked about pain intensity after surgery.
Experimental: Intra-articular block; Patients undergoing total knee arthroplasty received a intra-articular block during the surgical procedure.	Procedure: Intra-articular block; Patients who receive an intra-articular block at the time of surgery, fill out a questionnaire and undergo a muscle strength test before surgery, undergo functional tests, a muscle strength test and are asked about pain intensity after surgery.
No Intervention: Control group; Patients undergoing total knee arthroplasty and didn't receive pain block.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Timed up & go test	Total time to arise from chair, walk 3 m, turn around, return to chair and sit down. Two trials performed and the faster of the two is recorded to the nearest 10th of a second.	first and fifth day after the surgery
Change in Elderly mobility scale	The EMS is a 20 point validated assessment tool for the assessment of frail elderly subjects. The EMS is measured on an ordinal scale of 0-20, when Scores under 10 - generally these patients are dependent in mobility manoeuvres; require help with basic ADL, such as transfers, toileting and dressing. Scores between 10 - 13 - generally these patients are borderline in terms of safe mobility and independence in ADL i.e. they require some help with some mobility manoeuvres. Scores over 14 - Generally these patients are able to perform mobility manoeuvres alone and safely and are independent in basic ADL.	first and fifth day after the surgery
Change in 5 times sit to stand test	The score is the amount of time (to the nearest decimal in seconds) it takes a patient to transfer from a seated to a standing position and back to sitting five times.	first and fifth day after the surgery
Change in Numeric pain rating scale	An 11-point scale scored from 0 to 10: 0 = no pain, 10= the most intense pain imaginable	up to five days
Chane in Quadriceps muscle strength	muscle strength measure by dynamometer (N⋅m)	A 1 day before the surgery, first and fifth day after the surgery.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hospitalization duration	Number of days of hospitalization after the surgery- taken from the patient's file	At discharge (assessed up to day 10)
Surgery duration	minutes- taken from the patient's file	During the surgery
consumption of analgesics	taken from the patient's file	At discharge (assessed up to day 10)
occurrence of falls	throughout the hospitalization- taken from the patient's file	At discharge (assessed up to day 10)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Oxford knee score questionnaire	The OKS is a patient self-completion PRO containing 12 questions on activities of daily living. It provides a single summed score which reflects the severity of problems that the respondent has with their knee. The OKS is scored 0-48 when Score 0-19 May indicate severe knee arthritis. Score 20-29 May indicate moderate to severe knee arthritis. Score 30-39 May indicate mild to moderate knee arthritis. Score 40-48 May indicate satisfactory joint function.	A 1 day before the surgery

Collaborators and Investigators

• Sponsor: University of Haifa
• Collaborators: Western Galilee Hospital-Nahariya
• Investigators: Principal Investigator: Haim Shtarker, Dr, Head of the orthopedic department, Galilee medical center

Study record dates

Study Major Dates

• Study Start (Actual): November 1, 2022
• Primary Completion (Actual): July 21, 2023
• Study Completion (Actual): July 21, 2023

Study Registration Dates

• First Submitted: July 4, 2022
• First Submitted That Met QC Criteria: July 27, 2022
• First Posted (Actual): July 28, 2022

Study Record Updates

• Last Update Posted (Actual): October 23, 2023
• Last Update Submitted That Met QC Criteria: October 18, 2023
• Last Verified: October 1, 2023

More Information

Terms related to this study

• Keywords: pain; total knee replacement; post operative pain; nerve block; total knee arthroplasty; post operative function; intra-articular block
• Additional Relevant MeSH Terms: Pathologic Processes; Postoperative Complications; Pain; Neurologic Manifestations; Pain, Postoperative
• Other Study ID Numbers: UHaifa-MEGK

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No